Medicare Open Enrollment 2025: Key Changes and What You Need to Know

Open enrollment season is here, and if you're on Medicare or approaching eligibility, now is the time to review your coverage. We recently hosted a Medicare update webinar with senior insurance specialist Nylene Ellingson, of Senior Insurance Specialsts, who shared crucial information about this year's changes and options. Here are the key takeaways you need to know.

Important Dates to Remember

The annual enrollment period runs from October 15th through December 7th. This is your window to make changes to your Medicare coverage, whether you're switching between plans or exploring different options for the first time.

What's Changing in 2026

While many details are still being finalized, here's what we know for certain:

• Part D Drug Coverage: The maximum out-of-pocket cost is increasing from $2,000 to $2,100 (a modest $100 increase)
• Part D Deductible: Rising from $590 to $615
• Plan Changes: Some carriers, including United Healthcare in Maricopa County, have eliminated certain PPO plans, requiring members to find new coverage

Review Your Annual Notice of Change

Every September, Medicare beneficiaries receive an Annual Notice of Change from their plan provider. Unlike most mail you receive, this document is critical. It outlines any changes to your coverage, benefits, or costs for the upcoming year. Take time to review it carefully to ensure your current plan still meets your needs.

Understanding Your Two Main Options

-Medicare Supplement Plans (Medigap)

• You pay a monthly premium (typically $100-$400+)
• Minimal or no costs when you use healthcare services
• Works with any doctor who accepts Medicare nationwide
• Premium rates have been increasing significantly (some up to 25% this year)
• Plan G is now the most comprehensive option for new enrollees

-Medicare Advantage Plans (Part C)

• Usually zero monthly premium (beyond your Part B premium)
• Includes prescription drug coverage
• Offers extra benefits like dental, vision, hearing, and gym memberships
• Pay copays when you use services, with an annual maximum out-of-pocket limit ($2,300-$6,000)
• Must use network providers (though PPO plans offer out-of-network options)

Can You Switch?

Good news: You can try a Medicare Advantage plan risk-free. You do not have to be scared to try advantage. If you have never been on one, you have a 12 month trial period. At anytime in the first 12 months, if you are not happy with the plan, you can return to the supplement plan you left with no questions or underwriting.

Switching from an Advantage plan back to a supplement typically requires answering a few health questions (about cancer, COPD, recent hospitalizations, heart attacks, or strokes within the past two years). However, if your current plan is terminating, you can switch to a supplement without health underwriting.

Addressing Common Concerns

Many people worry that Advantage plans limit their doctor choices or deny necessary care. According to industry data and client experience, these concerns are largely overstated when working with major carriers like United Healthcare, Humana, Aetna, and Cigna, which maintain extensive provider networks. Most members on Advantage plans pay less than $300 annually in out-of-pocket medical costs.

Special Considerations

Traveling: If you travel and need a plan that works nationwide, you are not limited to a supplement. You can have a PPO and there are some HMO plans that work nationwide as well.

Veterans: Special Advantage plans are available that coordinate with VA benefits and help offset Part B premium costs.

Rural Areas: Some rural counties are experiencing plan changes. Contact a qualified broker to explore your local options.

The Bottom Line

Whether you choose a supplement or Advantage plan, both offer excellent coverage—they just work differently. The key is finding what fits your health needs, budget, and lifestyle. This enrollment period is your opportunity to shop around, especially if you have expensive medications or if your premium has increased significantly.

Don't navigate these decisions alone. Working with a licensed broker who represents multiple carriers and both types of plans ensures you receive unbiased guidance tailored to your situation.

Watch the full webinar replay for more detailed information and answers to commonly asked questions about Medicare coverage options. Tune in to our socials or listen to the KDI Wealth Alchemist on your favorite podcast platform!

The information provided is for educational purposes. For personalized Medicare advice, you can schedule a one-on-one appointment with Nylene Ellingson - contact information available on 10/25 on our podcast!